Chapter 6 — Exercises

Items marked † have worked solutions in Answers to Selected Exercises, along with every odd-numbered item.

A. Recall and vocabulary

6.1 Name the three code books, the question each answers, who maintains each, and when each changes.

6.2 What is ICD-10-PCS, and in which single setting is it used?

6.3 † Name the two parts of ICD-10-CM you use in a fixed order, plus the three specialty tables and the document at the front.

6.4 Why does the chapter say the most important part of CPT is the part people skip? Name it.

6.5 † List five things an encoder does not decide.

6.6 What is a grouper, and what is the underused diagnostic use the chapter recommends for it?

6.7 Distinguish the practice management system from the electronic health record by what each owns. Where does the coder sit?

6.8 † What is a superbill, why is it not a coding decision, and how does it decay?

6.9 Distinguish a scrubber from a clearinghouse. Which one is described as the highest-risk object in a billing system, and why?

6.10 State the three search techniques from §6.6.

6.11 † Draw the coder's year: name each recurring update and its date.

6.12 State the honest tension in §6.9 and the rule that resolves it.

B. Routing

For each question, name the source you would open first, and say why.

6.13 † Does this ICD-10-CM code require a seventh character?

6.14 May these two CPT codes be reported together on the same date?

6.15 † Is this service covered by Medicare for this patient's documented diagnosis?

6.16 How many units of this drug may be reported on one date of service?

6.17 † Does the global period for this procedure include the follow-up visit?

6.18 What does Medicare pay for this code in my locality?

6.19 † What belongs in item 17b of the CMS-1500?

6.20 A commercial payer denied a code pair and its policy is not published. What do you open, and what do you expect to find?

6.21 Your state's Medicaid program requires something and you cannot find it in any federal source. Where do you go?

C. Read the document

6.22 † A coder's encoder returns a code after a five-question logic pathway. State the two things the coder must do next, and explain why the encoder's output is not sufficient on its own.

6.23 A practice's superbill was built four years ago and has not been reviewed. List four distinct categories of error it is currently producing.

6.24 † A billing office cannot produce a list of its scrubber's automatic rules. Write the half-day project that fixes this: the steps, the output, and the ongoing control.

D. Judgment and process

6.25 It is October 4. You are working a queue containing encounters from September 26 through October 3. Describe exactly what you do differently this week, and why.

6.26 † Your new employer's productivity standard requires 60 minutes of work per hour and you consistently need 75. Describe the conversation you would have, what evidence you would bring, and what you would ask for.

6.27 A colleague says "just use the encoder, it's always right." Give the three-part response.

6.28 † You are asked, in your first week, "what do I do when I don't know the answer?" and the reply is "just pick something reasonable and move on." Write the follow-up question and explain what each possible answer tells you.

6.29 Design the personal reference file described in §6.10. What fields does each entry have, and why is a question list more useful than a code list?

6.30 † Your practice's encoder update for January 1 is scheduled for January 10. State the problem, the exposure, and what you would do between January 1 and January 10.

E. Certification-style questions

6.31 † ICD-10-CM is updated annually effective:

  • A. January 1
  • B. April 1
  • C. July 1
  • D. October 1

6.32 CPT is maintained by:

  • A. CMS
  • B. the American Medical Association
  • C. the National Center for Health Statistics
  • D. AAPC

6.33 † HCPCS Level II codes are updated:

  • A. annually on January 1
  • B. annually on October 1
  • C. quarterly
  • D. only when CMS issues a rule

6.34 Which of the following is generally not permitted in a code book brought to a certification exam?

  • A. handwritten notes in the margins
  • B. highlighting
  • C. tabs
  • D. photocopied reference pages taped into the book

6.35 † ICD-10-PCS is used to report:

  • A. physician office procedures
  • B. inpatient hospital procedures
  • C. outpatient hospital procedures
  • D. durable medical equipment

6.36 A code is assigned according to the code set in effect on the:

  • A. date of coding
  • B. date of service
  • C. date of submission
  • D. date of adjudication

F. Write it

6.37 † Write the one-page update-cycle checklist your practice would follow before each January 1 and October 1. Include who owns each item.

6.38 Draft the three questions from §6.5 as a memo to a billing supervisor, asking for a scrubber rule inventory without sounding like an accusation.

6.39 Write the tab list you would apply to a CPT professional edition. Justify each tab by naming the question it answers faster.

G. The Encounter

6.40 † Using the routing table in the Encounter checkpoint: for rows 6, 7, and 9, state precisely what distinct question each is asking, and explain why conflating them produces a confident wrong answer.

6.41 Row 13 says the winning appeal is built from three documents, none of which cost anything. Name them, and state which one no software could have supplied.

6.42 † Row 2's answer is "THE NOTE. Nothing else." Explain, using Chapter 4, why no reference book, encoder, or database appears in that row, and what that implies about the order of the other twelve rows.

6.43 Build your own routing table for a specialty you are interested in. Ten questions, ten sources. Keep it; you will use it.

6.44 Update your Encounter Workbook (Appendix C) with the routing table. For each of Q1, Q5, and Q6, write down the source that will resolve it and the chapter where the book does the work.